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Form 2218
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5073
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
FOR USE OF OFFICIALS SEARCHING IMMI-
NATURALIZATION SERVICE
GRATION RECORDS
CLERK OF COURT:
13-60-7749
33771
RECORDS EXAMINED
Place number
In
NATURALIZATION SERVION
CARD INDEX INDEX BOOKS 9/1/18
RECEIVED
upper left-hand corner of all copies of
declaration, immediately under your
declaration number.
MAY 24 1927
DISTRICT DIRECTOR OF NATURALIZATION.
MANIFESTS
OFFICE OF EXAMINER:
lles
EW HAVEN, CONN.
us two with
(NOTE TO CLERK OF COURT. To guide you in preparing the Declaration: The black face lines on this form contain statements
in the regular order as they are to appear on the Declaration of Intention.)
I desire to file my Declaration of Intention (first paper) to become a citizen.
MF.
My name is
Mrs.
Stanislawa (Alien should print or typewfite Keyenda here true, original, and Fedrogyki correct name
age,
378
years.
M
(Give age last birthday)
Also known as
(If alien has used any other name in this country, that name should be shown here)
I used that name because
The full name of the shown on ticket was
person my steamship Stanislawa Knajewska
My mother's maiden name was Rosalia Wischnewokis
My maiden name was (if woman) Stanislawa Krajewska
My present occcupation is housewife
My personal description is: Color, white ; complexion, medium ; height,
fair 54 feet 21144 inches;
weight, 126 pounds; color of hair, brown s color of eyes, brown
dark
;
other visible distinctive marks:
MAT D3 dofrightltwood
I was born in
Worus, of
Goland
(City or town)
(Country)
on the 22
day of
april
(889
My present residence is
Preston Newhondan Connecticut
(Number and street)
(City or town)
(County)
(State)
My post
office address is RF2 3 Norurch Come
The place where I took the ship-or train which landed me in the United States was Amsterdam
Holland Antwerp Belgine on Refs (Month) aug 28 to (Day) 19213 (Year
The ticket on which I came to this country was bought at Warsaw
Poland
The name or on came
of the ship railroad which I was Rad Star (City) p (Country) 014-8
(OVER)
10-6-v3
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"ocrText": "Form 2218\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5073\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nCLERK OF COURT:\n13-60-7749\n33771\nRECORDS EXAMINED\nPlace number\nIn\nNATURALIZATION SERVION\nCARD INDEX INDEX BOOKS 9/1/18\nRECEIVED\nupper left-hand corner of all copies of\ndeclaration, immediately under your\ndeclaration number.\nMAY 24 1927\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\nOFFICE OF EXAMINER:\nlles\nEW HAVEN, CONN.\nus two with\n(NOTE TO CLERK OF COURT. To guide you in preparing the Declaration: The black face lines on this form contain statements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMF.\nMy name is\nMrs.\nStanislawa (Alien should print or typewfite Keyenda here true, original, and Fedrogyki correct name\nage,\n378\nyears.\nM\n(Give age last birthday)\nAlso known as\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nThe full name of the shown on ticket was\nperson my steamship Stanislawa Knajewska\nMy mother's maiden name was Rosalia Wischnewokis\nMy maiden name was (if woman) Stanislawa Krajewska\nMy present occcupation is housewife\nMy personal description is: Color, white ; complexion, medium ; height,\nfair 54 feet 21144 inches;\nweight, 126 pounds; color of hair, brown s color of eyes, brown\ndark\n;\nother visible distinctive marks:\nMAT D3 dofrightltwood\nI was born in\nWorus, of\nGoland\n(City or town)\n(Country)\non the 22\nday of\napril\n(889\nMy present residence is\nPreston Newhondan Connecticut\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post\noffice address is RF2 3 Norurch Come\nThe place where I took the ship-or train which landed me in the United States was Amsterdam\nHolland Antwerp Belgine on Refs (Month) aug 28 to (Day) 19213 (Year\nThe ticket on which I came to this country was bought at Warsaw\nPoland\nThe name or on came\nof the ship railroad which I was Rad Star (City) p (Country) 014-8\n(OVER)\n10-6-v3"
}